What this medicine is used for

The name of your medicine is Chemmart Carvedilol. It contains the active ingredient, carvedilol.

It is used to treat high blood pressure and, together with other medicines, to help treat congestive heart failure.

Ask your doctor if you have any questions about why this medicine has been prescribed for you.

Your doctor may have prescribed this medicine for another reason.

This medicine is available only with a doctor's prescription.

How it works

Carvedilol belongs to a group of medicines called beta-blockers.

These medicines work by relaxing tightened blood vessels and slowing the heart rate. Carvedilol has the additional effect
of being an antioxidant.

Heart failure occurs when the heart can no longer pump blood strongly enough for the body's needs. Often the heart grows in
size to try to improve the blood flow but this can make the heart failure worse.

Symptoms of heart failure include shortness of breath and swelling of the feet or legs due to fluid build-up.

Carvedilol reduces the pressure that the heart has to pump against as well as controlling your heart rate. Over 6 months or
more, this will reduce the size of an oversized heart and increase its efficiency.

Carvedilol reduces the chances of you being admitted to hospital for this condition.

Carvedilol is often used with other medicines to treat heart failure.

All people have blood pressure. This pressure helps to push blood all around your body. Your blood pressure changes during
the day, depending on how busy you are or how you are feeling.

You have high blood pressure when your blood pressure stays higher than is needed, even when you are calm and relaxed.

Regular blood pressure checks are the only way of knowing that you have high blood pressure. There are usually no symptoms
of high blood pressure and you may feel fine. If high blood pressure is not treated, serious health problems such as stroke,
heart disease and kidney failure may occur.

Carvedilol helps to lower your blood pressure.

There is no evidence that the medicine is addictive.

Use in children

There is not enough information to recommend using this medicine for children.

Before you take this medicine

When you must not take it

Do not take this medicine if:

You have or have had any of the following:

a very slow heart rate or uneven heart beating or certain other heart problems such as 2nd or 3rd degree AV block. Carvedilol
is not suitable for people with these types of heart problem

a very serious type of heart failure (with swelling of your hands, ankles and feet) which is being treated by medicines given
into your veins (intravenously)

liver problems

very low blood pressure

asthma, wheezing or other conditions which make you short of breath from time to time

allergic disorders, including hayfever or allergies which cause asthma or nose running/congestion You have been told that
you are suffering from shock

You are allergic to lactose. This medicine contains lactose.

You have had an allergic reaction to carvedilol or any of the ingredients listed at the end of this leaflet.

Symptoms of an allergic reaction may include cough, shortness of breath, wheezing or difficulty breathing; swelling of the
face, lips, tongue, throat or other parts of the body, rash itching or hives on the skin, fainting or hayfever-like symptoms.

If you think you are having an allergic reaction, contact your doctor immediately or go to the Accident and Emergency department
at the nearest hospital.

The expiry date (EXP) printed on the pack has passed.

The packaging is torn, shows signs of tampering or it does not look quite right.

Before you start to take it

Before you start taking this medicine, tell your doctor if:

1.You have allergies to:

any other medicines

any other substances, such as foods, preservatives or dyes.

2.You have or have had any medical conditions, especially the following:

a growth on one of your adrenal glands ('phaeochromocytoma')

angina or chest pain/tightness which occurs even when you are at rest (also called unstable angina or Prinzmetal's variant
angina)

slow heart rate (bradycardia)

low blood pressure

high blood pressure which varies widely or which is due to a different medical problem

skin disease such as psoriasis (hardened patches of red skin), or a previous history of developing psoriasis when taking beta-blockers

3.You are pregnant or plan to become pregnant.

It is not known whether carvedilol is harmful to an unborn baby when taken by a pregnant woman. If there is a need to take
carvedilol when you are pregnant your doctor will discuss the risks and benefits to you and the unborn baby.

4.You are breastfeeding or plan to breastfeed.

Carvedilol passes into breast milk. Your doctor will discuss the risks and benefits of taking carvedilol if you are breast-feeding.

5.You wear contact lenses.

You may not produce as many tears, so wearing contact lenses may be more difficult. Consider using artificial tears if this
happens.

6.You are intolerant or allergic to lactose.

This medicine contains lactose.

7.You plan to have surgery.

Your surgeon and anaesthetist should know well ahead of the date of your surgery so they can allow for your condition and
medications.

8.You are currently receiving or are planning to receive dental treatment.

9.You are taking or are planning to take any other medicines.

This includes vitamins and supplements that are available from your pharmacy, supermarket or health food shop.

Some medicines may interact with carvedilol. These include:

rifampicin, a medicine used to treat tuberculosis (e.g. Rimycin, Rifadin)

cimetidine, a medicine used to treat stomach ulcers or reflux

digoxin, a medicine used to treat heart failure

medicines used to treat depression, such as monoamine-oxidase inhibitors (MAOls), e.g. phenelzine, tranylcypromine, and reserpine;
or SSRIs such as fluoxetine and paroxetine.

other monoamine oxidase inhibitors

clonidine, a medicine used to treat high blood pressure, migraine or menopausal symptoms (e.g. Catapres)

cyclosporin, a medicine used to treat certain problems with the immune system or after organ transplants to protect against
rejection

drugs used during anaesthetics, such as ether, cyclopropane and trichloroethylene

medicines usually inhaled to treat asthma called beta agonists. These include salbutamol, terbutaline and salmeterol

anti-inflammatory medicines for treating pain and inflammation, such as ibuprofen, naproxen, aspirin and diclofenac.

If you are taking any of these you may need a different dose or you may need to take different medicines or you may need to
be closely monitored for side effects.

Other medicines not listed above may also interact with carvedilol.

Grapefruit juice may also affect your blood levels of carvedilol.

How to take this medicine

Follow carefully all directions given to you by your doctor or pharmacist. Their instructions may be different to the information
in this leaflet.

How much to take

Your doctor or pharmacist will tell you how much of this medicine you should take. This will depend on your condition and
whether you are taking any other medicines.

Heart Failure

The usual starting dose in heart failure is 3.125 mg twice daily. The dose is usually increased every two weeks to 6.25 mg
twice daily, 12.5 mg twice daily and then 25 mg twice daily. However, this may be done more slowly if side effects occur.
If the tablets slow your heart too much you may go back to a lower dose.

High Blood Pressure

The usual starting dose in high blood pressure is once daily.

Adults:

The recommended dose for initiation of therapy is 12.5 mg a day for the first two days.

Thereafter, the recommended dosage is 25 mg once a day.

If necessary, the dosage may subsequently be increased at intervals of at least two weeks up to the recommended maximum daily
dose of 50 mg given once a day or in divided doses (twice daily).

Elderly:

The recommended dose for initiation of therapy is 12.5 mg once daily, which has provided satisfactory control in some patients.
If the response is inadequate, the dose may be titrated at intervals of at least two weeks up to the recommended maximum daily
dose.

Your doctor will monitor you carefully each time the dose is increased.

Do not stop taking your medicine or change your dosage without first checking with your doctor.

How to take it

Swallow tablets whole or halved with a glass of water.

Do not crush or chew the tablets.

When to take it

Take this medicine during or immediately after a meal, at about the same time each day.

Taking it medicine at the same time each day will have the best effect. It will also help you remember when to take it.

If you take carvedilol on an empty stomach, it may increase the risk of some of the side effects.

How long to take it for

Continue taking your medicine for as long as your doctor tells you.

Make sure you have enough to last over weekends and holidays.

It is very important that you do not suddenly stop taking carvedilol. If you are to stop taking it, your doctor will advise
you to reduce the dose slowly over approximately two weeks.

If you forget to take it

If it is almost time to take your next dose, skip the missed dose and take your next dose at the usual time. Otherwise take
it as soon as you remember, and then go back to taking your medicine as you would normally.

Do not take a double dose to make up for missed doses.

This may increase the chance of unwanted side effects.

If you have trouble remembering to take your medicine, ask your pharmacist for some hints.

If you take too much (overdose)

If you think that you or anyone else may have taken too much of this medicine, immediately telephone your doctor or the Poisons
Information Centre (Tel: 13 11 26 in Australia) for advice. Alternatively go to the Accident and Emergency Department at your
nearest hospital.

Do this even if there are no signs of discomfort or poisoning. You may need urgent medical attention.

The following are some symptoms, which may or may not occur:

low blood pressure, causing dizziness or fainting

a very slow heart rate

difficulty breathing

vomiting

shock

seizures (fits).

While you are taking this medicine

Things you must do

Tell your doctor that you are taking this medicine if:

you are about to be started on any new medicine

you become pregnant or plan to breastfeed

you are going to have surgery (tell your surgeon and anaesthetist)

you develop a very slow heart rate

you develop low blood pressure (light-headedness, fainting); this is most likely to happen when you first start taking carvedilol
or when you increase the dose.

you develop dark urine, jaundice and/or you have pain in your upper right side of your abdomen.

you develop kidney problems.

Your doctor may occasionally do blood or urine tests to make sure the medicine is working and to prevent side effects. Go
to your doctor regularly for a check-up.

Monitor your blood glucose levels regularly if you are diabetic, especially when you start or stop taking this medicine or
increase the dose.

Have regular eye examinations from your eye doctor.

Tell all doctors, dentists and pharmacists who are treating you that you take this medicine.

Make sure you drink enough water during exercise and hot weather, especially if you sweat a lot.

Tell your doctor if, for any reason, you have not taken your medicine exactly as prescribed.

Otherwise, your doctor may think that it was not effective and change your treatment unnecessarily.

Tell your doctor if you feel the tablets are not helping your condition.

Things you must not do

Do not:

Give this medicine to anyone else even if their symptoms seem similar to yours

take your medicine to treat any other condition unless your doctor or pharmacist tells you to

stop taking your medicine, or change the dosage, without first checking with your doctor. Carvedilol should only be discontinued
gradually over two weeks

let yourself run out of medicine over the weekend or on holidays.

Things to be careful of

Be careful driving or operating machinery until you know how this medicine affects you.

Carvedilol may affect your ability to drive a car or operate machinery when started or when the dosage is increased, or when
it is taken with alcohol.

If you feel light-headed, dizzy or faint when getting out of bed or standing up, get up slowly.

If you wear contact lenses you may also notice a reduction in the amount of tear fluid in your eyes.

Consider using artificial tears to wet the eye if this happens.

When taken with grapefruit juice, the amount of carvedilol absorbed by your body may be increased.

If you need to stop taking carvedilol, follow your doctor's instructions and gradually discontinue it over 2 weeks. During
this time limit the amount of exercise you do and tell your doctor if your blood pressure or heart failure symptoms get worse.

Possible side effects

Tell your doctor or pharmacist as soon as possible if you do not feel well while you are taking carvedilol or if you have
any questions or concerns.

Do not be alarmed by the following lists of side effects. You may not experience any of them. All medicines can have side
effects. Sometimes they are serious but most of the time they are not.

Tell your doctor or pharmacist if you notice any of the following:

tiredness, sleepiness, weakness, drowsiness or feeling lethargic

dizziness or giddiness

wind

loss of appetite

indigestion

problems sleeping or getting to sleep

problems concentrating

headache (this is usually mild and happens at the start of your treatment)

problems with sight (abnormal or blurry vision) or hearing

diarrhoea, nausea, stomach pain or vomiting

constipation

pain in your back, muscles or joints

muscle weakness

stuffy nose

mild rash

leg or muscle cramps

numbness or tingling in your fingers

sore throat

inflamed gums

bruising

hair loss

memory loss

dry mouth, increased sweating

increase sensitivity to touch, sight or smell

weight increase

increase in cholesterol levels (shown by a blood test)

being unable to get an erection (erectile dysfunction) or lacking sex drive

Tell your doctor as soon as possible if you notice any of the following.

These may be serious side effects. You may need medical attention.

feeling depressed

problems with blood circulation in your arms and legs. The signs include cold hands and feet, whiteness, tingling and pain
in your fingers and a pain in your leg which gets worse when you walk

problems with your heart when increasing the dose. The signs include chest pains, tiredness, shortness of breath and swelling
of your arms and legs

breathing problems or coughing or chest infection such as bronchitis

fever

migraine

thinking strange thoughts or feeling paranoid or emotionally unstable

moderate skin rashes, feeling itchy and dry skin patches

excessive sunburn-type rash after only a short time in the sun

low numbers of all types of white blood cells. The signs include infections of the mouth, gums, throat and lungs

low number of platelets in your blood. The signs include bruising easily and nose bleeds

changes in your blood shown up by a blood test

hyperkalaemia (too much potassium in your blood)

anaemia

high blood pressure (sometimes this can only be measured, but you may have a headache)

fast, slow or irregular heart rate

low blood pressure The signs include feeling dizzy or light-headed, in particular after you stand up.

fainting

stuffy nose, wheezing and flu-like symptoms

sore eyes

pain when passing urine, blood in the urine or changes in how often or how much urine you pass

black tarry stools

high blood sugar levels or developing the signs of diabetes or having trouble controlling your blood sugar if you have diabetes

some women may have difficulty with bladder control (urinary incontinence). This normally will get better when treatment
is stopped.

If you experience any of the following, stop taking your medicine and contact your doctor immediately or go to the Accident
and Emergency department at your nearest hospital.

These are very serious side effects and are usually very rare. You may need urgent medical attention or hospitalisation.

itching, dark urine, loss of appetite, yellowing of skin or eyes, or feeling "flu-like" for no known reason

convulsions or fits

shortness of breath

chest pain or tightness

uneven or slow heart beating or other heart problems

swelling of the feet or legs due to fluid build up

serious rashes which cover much of your body and may have blisters or flaking patches of skin

sudden onset of the symptoms of stroke - such as being unable to smile, having droopy mouth and/or eyes, problems speaking
or understanding, confusion and/or unconsciousness.

Other side effects not listed above may occur in some patients.

Allergic reactions

If you think you are having an allergic reaction to carvedilol, stop taking this medicine and tell your doctor immediately
or go to the Accident and Emergency department at your nearest hospital.

Symptoms of an allergic reaction may include some or all of the following:

cough, shortness of breath, wheezing or difficulty breathing

swelling of the face, lips, tongue, throat or other parts of the body

rash, itching or hives on the skin

fainting

hayfever-like symptoms

Storage and disposal

Storage

Keep your medicine in its original packaging until it is time to take it.

If you take your medicine out of its original packaging it may not keep well.

Keep your medicine in a cool dry place, where the temperature will stay below 25°C. Protect it from light and moisture.

Do not store your medicine, or any other medicine, in the bathroom or near a sink. Do not leave it on a window sill or in
the car. Heat and dampness can destroy some medicines.

Keep this medicine where children cannot reach it.

A locked cupboard at least one-and-a-half metres above the ground is a good place to store medicines.

Disposal

If your doctor or pharmacist tells you to stop taking the tablets or it has passed its expiry date, your pharmacist can dispose
of the remaining medicine safely.

Product description

What Chemmart Carvedilol looks like

3.125 mg tablets:

White oval shaped, film-coated tablets, imprinted with "P" logo on one side and plain on the other side.

Blister packs of 30 tablets.

6.25 mg tablets:

White oval shaped, film-coated tablets, imprinted "6.25" on one side and "P" logo on the other side.

Blister packs of 30 and 60 tablets.

12.5 mg tablets:

White oval shaped, film-coated tablets, imprinted "12.5" on one side and "P" logo on the other side.

Blister packs of 60 tablets.

25 mg tablets:

White oval shaped, film-coated tablets, imprinted "25" on one side and "P" logo on the other side.

It is important to keep in mind that nontuberculous mycobacteria are environmental, and so unlike mycobacterial tuberculosis, generally this is not a person to person transmitted disease. The organisms are found universally in water and soil and so most people are exposed on a daily basis.

Aging is the continuing process of such stress exposures, and with advancing age (normal aging), we must carry lots of senescent cells within our bodies. Senescent cells also often provide some ‘bad influences’ to surrounding healthy cells; such as chronic inflammation and tumorigenesis

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